In modern high-tech health care, patients appear to be the stumbling block.
Uninformed, anxious, noncompliant individuals with unhealthy lifestyles who demand treatments advertised by celebrities, insist on unnecessary but expensive imaging, and may eventually turn into plaintiffs. But what about their physicians? About ten years ago, Muir Gray and Gerd Gigerenzer published a book with the subtitle “Envisioning health care 2020”. They listed “seven sins” of health care systems then, one of which was health professionals’ stunning lack of risk literacy. Many were not exactly sure what a false-positive rate was, or what overdiagnosis and survival rates mean, and they were unable to evaluate articles in their own field. As a consequence, the ideals of informed consent and shared decision-making remain a pipedream – both doctors and patients are habitually misled by biased information in health brochures and advertisements. At the same time, the risk literacy problem is one of the few in health care that actually have a known solution. A quick cure is to teach efficient risk communication that fosters transparency as opposed to confusion, both in medical school and in CME. It can be done with 4th graders, so it should work with doctors, too.
Now, in 2020, can every doctor understand health statistics? In this talk, Gerd Gigerenzer will describe the efforts towards this goal, a few successes, but also the steadfast forces that undermine doctors’ ability to understand and act on evidence. Moreover, the last decade has seen two new forces that distract from solving the problem. The first is the promise of digital technology, from diagnostic AI systems to big data analytics, which consumes much of the attention. Digital technology is of little help if doctors do not understand it. Second, our efforts to make patients competent and to encourage them to articulate their values are now in conflict with the new paternalistic view that patients just need to be nudged into better behaviour.
Joint event with: The Oxford–Berlin Research Partnership